Abstract：
BACKGROUND: Pancreaticoduodenectomy is a complex intra-abdominal operation used for the treatment of benign and malignant disease of the pancreatic head or periampullary region. Despite developments in surgical techniques, pancreaticoduodenectomy is still associated with high rate of postoperative complications. We performed this systematic review and meta-analysis to compare the surgical outcomes of isolated Roux-en-Y pancreaticojejunostomy (IRYPJ), and conventional pancreaticojejunostomy(CPJ).
METHODS: We performed a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. We searched the following electronic databases - PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Clinical-Trials.gov. Published trials comparing the efficacy and safety of IRYPJ and CPJ after pancreaticoduodenectomy were evaluated. The search terms were \"pancreaticoduodenectomy,\" \"Whipple,\" \"pylorus-preserving pancreaticoduodenectomy,\" \"pancreaticojejunostomy,\" \"Roux-en-Y,\" and \"isolated Roux loop pancreaticojejunostomy.\" Only randomised controlled trials comparing outcome of IRYPJ and CPJ after pancreaticoduodenectomy were included. The analysed outcome measures were postoperative pancreatic fistula (POPF), clinically relevant POPF (CR-POPF), bile leak and delayed gastric emptying (DGE).
RESULTS: The initial search yielded 342 results but only four randomised control trials fulfilled the inclusion criteria and were included for data synthesis and meta-analysis. Meta-analysis of POPF revealed that IRYPJ is associated with less POPF compared to CPJ but the difference was not statistically significant (risk ratio = 0.58, p = 0.56). A similar finding was also observed with CR-POPF (risk ratio = 0.17, p = 0.87) and DGE (risk ratio = 0.74, p = 0.46).
CONCLUSIONS: Isolated Roux-en-Y pancreaticojejunostomy is not associated with a superior outcome when compared to CPJ.
METHODS: We performed a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. We searched the following electronic databases - PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Clinical-Trials.gov. Published trials comparing the efficacy and safety of IRYPJ and CPJ after pancreaticoduodenectomy were evaluated. The search terms were \"pancreaticoduodenectomy,\" \"Whipple,\" \"pylorus-preserving pancreaticoduodenectomy,\" \"pancreaticojejunostomy,\" \"Roux-en-Y,\" and \"isolated Roux loop pancreaticojejunostomy.\" Only randomised controlled trials comparing outcome of IRYPJ and CPJ after pancreaticoduodenectomy were included. The analysed outcome measures were postoperative pancreatic fistula (POPF), clinically relevant POPF (CR-POPF), bile leak and delayed gastric emptying (DGE).
RESULTS: The initial search yielded 342 results but only four randomised control trials fulfilled the inclusion criteria and were included for data synthesis and meta-analysis. Meta-analysis of POPF revealed that IRYPJ is associated with less POPF compared to CPJ but the difference was not statistically significant (risk ratio = 0.58, p = 0.56). A similar finding was also observed with CR-POPF (risk ratio = 0.17, p = 0.87) and DGE (risk ratio = 0.74, p = 0.46).
CONCLUSIONS: Isolated Roux-en-Y pancreaticojejunostomy is not associated with a superior outcome when compared to CPJ.
摘要：
背景：胰十二指肠切除术是一种复杂的腹腔内手术，用于治疗胰头或壶腹周围区域的良性和恶性疾病。尽管外科技术有了发展，胰十二指肠切除术的术后并发症发生率仍然很高。我们进行了系统评价和荟萃分析，以比较孤立的Roux-en-Y胰肠吻合术（IRYPJ）的手术结果，和常规胰肠吻合术（CPJ）。
方法：我们根据系统评价和荟萃分析（PRISMA）声明的首选报告项目进行了系统评价和荟萃分析。我们搜索了以下电子数据库——PubMed，Embase,WebofScience,Cochrane中央对照试验登记册（中央），和临床试验。评估了比较胰十二指肠切除术后IRYPJ和CPJ的疗效和安全性的已发表试验。搜索词是“胰十二指肠切除术，\"\"Whipple,保留幽门的胰十二指肠切除术，\"\"胰肠吻合术,\"\"Roux-en-Y,“和”孤立的Roux环胰空肠吻合术。“仅包括比较胰十二指肠切除术后IRYPJ和CPJ结果的随机对照试验。分析结果测量为术后胰瘘（POPF），临床相关POPF（CR-POPF），胆漏和胃排空延迟（DGE）。
结果：初步检索得出342个结果，但只有4个随机对照试验符合纳入标准，纳入数据综合和荟萃分析。POPF的Meta分析显示，与CPJ相比，IRYPJ与较少的POPF相关，但差异无统计学意义（风险比=0.58，p=0.56）。CR-POPF（风险比=0.17，p=0.87）和DGE（风险比=0.74，p=0.46）也观察到类似的发现。
结论：与CPJ相比，孤立的Roux-en-Y胰肠吻合术与更好的结局无关。
方法：我们根据系统评价和荟萃分析（PRISMA）声明的首选报告项目进行了系统评价和荟萃分析。我们搜索了以下电子数据库——PubMed，Embase,WebofScience,Cochrane中央对照试验登记册（中央），和临床试验。评估了比较胰十二指肠切除术后IRYPJ和CPJ的疗效和安全性的已发表试验。搜索词是“胰十二指肠切除术，\"\"Whipple,保留幽门的胰十二指肠切除术，\"\"胰肠吻合术,\"\"Roux-en-Y,“和”孤立的Roux环胰空肠吻合术。“仅包括比较胰十二指肠切除术后IRYPJ和CPJ结果的随机对照试验。分析结果测量为术后胰瘘（POPF），临床相关POPF（CR-POPF），胆漏和胃排空延迟（DGE）。
结果：初步检索得出342个结果，但只有4个随机对照试验符合纳入标准，纳入数据综合和荟萃分析。POPF的Meta分析显示，与CPJ相比，IRYPJ与较少的POPF相关，但差异无统计学意义（风险比=0.58，p=0.56）。CR-POPF（风险比=0.17，p=0.87）和DGE（风险比=0.74，p=0.46）也观察到类似的发现。
结论：与CPJ相比，孤立的Roux-en-Y胰肠吻合术与更好的结局无关。
